1
|
Hardy N, Vegivinti CTR, Mehta M, Thurnham J, Mebane A, Pederson JM, Tarchand R, Shivakumar J, Olaniran P, Gadodia R, Ganguly A, Kelagere Y, Nallabolu RR, Gaddam M, Keesari PR, Pulakurthi YS, Reddy R, Kallmes K, Musunuru TN. Mortality of COVID-19 in patients with hematological malignancies versus solid tumors: a systematic literature review and meta-analysis. Clin Exp Med 2023; 23:1945-1959. [PMID: 36795239 PMCID: PMC9933827 DOI: 10.1007/s10238-023-01004-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Cancer patients are more vulnerable to COVID-19 compared to the general population, but it remains unclear which types of cancer have the highest risk of COVID-19-related mortality. This study examines mortality rates for those with hematological malignancies (Hem) versus solid tumors (Tumor). PubMed and Embase were systematically searched for relevant articles using Nested Knowledge software (Nested Knowledge, St Paul, MN). Articles were eligible for inclusion if they reported mortality for Hem or Tumor patients with COVID-19. Articles were excluded if they were not published in English, non-clinical studies, had insufficient population/outcomes reporting, or were irrelevant. Baseline characteristics collected included age, sex, and comorbidities. Primary outcomes were all-cause and COVID-19-related in-hospital mortality. Secondary outcomes included rates of invasive mechanical ventilation (IMV) and intensive care unit (ICU) admission. Effect sizes from each study were computed as logarithmically transformed odds ratios (ORs) with random-effects, Mantel-Haenszel weighting. The between-study variance component of random-effects models was computed using restricted effects maximum likelihood estimation, and 95% confidence intervals (CIs) around pooled effect sizes were calculated using Hartung-Knapp adjustments. In total, 12,057 patients were included in the analysis, with 2,714 (22.5%) patients in the Hem group and 9,343 (77.5%) patients in the Tumor group. The overall unadjusted odds of all-cause mortality were 1.64 times higher in the Hem group compared to the Tumor group (95% CI: 1.30-2.09). This finding was consistent with multivariable models presented in moderate- and high-quality cohort studies, suggestive of a causal effect of cancer type on in-hospital mortality. Additionally, the Hem group had increased odds of COVID-19-related mortality compared to the Tumor group (OR = 1.86 [95% CI: 1.38-2.49]). There was no significant difference in odds of IMV or ICU admission between cancer groups (OR = 1.13 [95% CI: 0.64-2.00] and OR = 1.59 [95% CI: 0.95-2.66], respectively). Cancer is a serious comorbidity associated with severe outcomes in COVID-19 patients, with especially alarming mortality rates in patients with hematological malignancies, which are typically higher compared to patients with solid tumors. A meta-analysis of individual patient data is needed to better assess the impact of specific cancer types on patient outcomes and to identify optimal treatment strategies.
Collapse
Affiliation(s)
| | | | - Mansi Mehta
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - John M Pederson
- Nested Knowledge, Inc, St Paul, MN, USA
- Superior Medical Experts, St. Paul, MN, USA
| | | | - Jeevan Shivakumar
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY, USA
| | | | - Ritika Gadodia
- Medstar Washington Hospital Center/Georgetown University, Washington, DC, USA
| | - Arup Ganguly
- University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Yashaswini Kelagere
- Department of Pediatrics, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | | | | | - Praneeth R Keesari
- Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India
| | | | - Rohit Reddy
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Tejo N Musunuru
- Department of Hematology/Oncology, University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
2
|
Jani CT, Schooley RT, Mckay RR, Lippman SM. Cancer, more than a “COVID-19 co-morbidity”. Front Oncol 2023; 13:1107384. [PMID: 36994197 PMCID: PMC10040761 DOI: 10.3389/fonc.2023.1107384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Patients with cancer represent a particularly vulnerable population at risk of adverse outcomes related to COVID-19. Collectively, the initial studies, including patients with and without cancer, confirmed that patients with cancer had a higher risk of complications and death related to COVID-19. Subsequent studies on patients with COVID-19 and cancer investigated patient and disease-related factors associated with COVID-19 severity and morality. Multiple interconnected factors include demographics, comorbidities, cancer-associated variables, treatment side effects, and other parameters. However, there is a lack of clarity on the contributions of any one factor. In this commentary, we deconvolute the data of specific risk factors associated with worse outcomes due to COVID-19 in cancer patients and focus on understanding the recommended guidelines to mitigate COVID-19 risk in this vulnerable population. In the first section, we highlight the key parameters, including age and race, cancer status, type of malignancy, cancer therapy, smoking status and comorbidities that impact outcomes for cancer patients with COVID-19. Next, we discuss efforts made at the patient, health system, and population levels to mitigate the effects of the ongoing outbreak for patients with cancer, including (1) screening, barrier and isolation strategies (2), Masking/PPE (3), vaccination, and (4) systemic therapies (e.g., evusheld) to prevent disease onset in patients. In the last section, we discuss optimal treatment strategies for COVID-19, including additional therapies for patients with COVID-19 and cancer. Overall, this commentary focuses on articles with high yield and impact on understanding the evolving evidence of risk factors and management guidelines in detail. We also emphasize the ongoing collaboration between clinicians, researchers, health system administrators and policymakers and how its role will be important in optimizing care delivery strategies for patients with cancer. Creative patient-centered solutions will be critical in the coming years, post the pandemic.
Collapse
Affiliation(s)
- Chinmay T. Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Robert T. Schooley
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Rana R. Mckay
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
- *Correspondence: Rana R. Mckay,
| | - Scott M. Lippman
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| |
Collapse
|
3
|
Moss P, Berenbaum F, Curigliano G, Grupper A, Berg T, Pather S. Benefit-risk evaluation of COVID-19 vaccination in special population groups of interest. Vaccine 2022; 40:4348-4360. [PMID: 35718592 PMCID: PMC9135663 DOI: 10.1016/j.vaccine.2022.05.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
Several population groups display an increased risk of severe disease and mortality following SARS-CoV-2 infection. These include those who are immunocompromised (IC), have a cancer diagnosis, human immunodeficiency virus (HIV) infection or chronic inflammatory disease including autoimmune disease, primary immunodeficiencies, and those with kidney or liver disease. As such, improved understanding of the course of COVID-19 disease, as well as the efficacy, safety, and benefit-risk profiles of COVID-19 vaccines in these vulnerable groups is paramount in order to inform health policy makers and identify evidence-based vaccination strategies. In this review, we seek to summarize current data, including recommendations by national health authorities, on the impact and benefit-risk profiles of COVID-19 vaccination in these populations. Moving forward, although significant efforts have been made to elucidate and characterize COVID-19 disease course and vaccine responses in these groups, further larger-scale and longer-term evaluation will be instrumental to help further guide management and vaccination strategies, particularly given concerns about waning of vaccine-induced immunity and the recent surge of transmission with SARS-CoV-2 variants of concern.
Collapse
Affiliation(s)
- Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK; Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Francis Berenbaum
- Sorbonne University, INSERM, AP-HP Saint-Antoine Hospital, Paris, France
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ayelet Grupper
- Department of Nephrology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, 04103 Leipzig, Germany
| | | |
Collapse
|
4
|
Aslam M, Barkat K, Malik NS, Alqahtani MS, Anjum I, Khalid I, Tulain UR, Gohar N, Zafar H, Paiva-Santos AC, Raza F. pH Sensitive Pluronic Acid/Agarose-Hydrogels as Controlled Drug Delivery Carriers: Design, Characterization and Toxicity Evaluation. Pharmaceutics 2022; 14:pharmaceutics14061218. [PMID: 35745795 PMCID: PMC9229590 DOI: 10.3390/pharmaceutics14061218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to fabricate and evaluate a pH sensitive cross-linked polymeric network through the free radical polymerization technique for the model drug, cyclophosphamide, used in the treatment of non-Hodgkin’s lymphoma. The Hydrogels were prepared using a polymeric blend of agarose, Pluronic acid, glutaraldehyde, and methacrylic acid. The prepared hydrogels were characterized for drug loading (%), swelling pattern, release behavior, the ingredient’s compatibility, structural evaluation, thermal integrity, and toxicity evaluation in rabbits. The new polymer formation was evident from FTIR findings. The percentage loaded into the hydrogels was in the range of 58.65–75.32%. The developed hydrogels showed significant differences in swelling dynamics and drug release behavior in simulated intestinal fluid (SIF) when compared with simulated gastric fluid (SGF). The drug release was persistent and performed in a controlled manner for up to 24 h. A toxicity study was conducted on white albino rabbits. The developed hydrogels did not show any signs of ocular, skin, or oral toxicity; therefore, these hydrogels can be regarded as safe and potential carriers for controlled drug delivery in biomedical applications.
Collapse
Affiliation(s)
- Mariam Aslam
- Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (M.A.); (I.A.)
| | - Kashif Barkat
- Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (M.A.); (I.A.)
- Correspondence: (K.B.); (F.R.)
| | - Nadia Shamshad Malik
- Faculty of Pharmacy, Capital University of Science and Technology (CUST), Islamabad 44000, Pakistan; (N.S.M.); (N.G.)
| | - Mohammed S. Alqahtani
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Irfan Anjum
- Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan; (M.A.); (I.A.)
| | - Ikrima Khalid
- Faculty of Pharmaceutical Sciences, GC University, Faisalabad 38000, Pakistan;
| | - Ume Ruqia Tulain
- Faculty of Pharmacy, University of Sargodha, Sargodha 40100, Pakistan;
| | - Nitasha Gohar
- Faculty of Pharmacy, Capital University of Science and Technology (CUST), Islamabad 44000, Pakistan; (N.S.M.); (N.G.)
| | - Hajra Zafar
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan, Road, Shanghai 200240, China;
| | - Ana Cláudia Paiva-Santos
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Faisal Raza
- Faculty of Pharmacy, Capital University of Science and Technology (CUST), Islamabad 44000, Pakistan; (N.S.M.); (N.G.)
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan, Road, Shanghai 200240, China;
- Correspondence: (K.B.); (F.R.)
| |
Collapse
|
5
|
Ma J, Zhu C, Li W, Qiu Z, Yang J, Ge L, Da M. The Effect of Delayed Oncology Surgery on Survival Outcomes for Patients With Gastric Cancer During the COVID-19 Pandemic: Evidence-Based Strategies. Front Oncol 2022; 12:780949. [PMID: 35664784 PMCID: PMC9162578 DOI: 10.3389/fonc.2022.780949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/12/2022] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate the impact of delay in gastrectomy on gastric cancer patients’ survival outcomes during the COVID-19 pandemic. Methods Databases including PubMed, MEDLINE (using the Ovid platform), Embase, the Cochrane Library, COVID-19 Open Research Dataset Challenge, COVID-19 Research Database (WHO), ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform were searched for studies of any design and in any setting that included patients with gastric cancer from their inception to July 31, 2021. Hazard ratio (HR) and 95% confidence intervals (CI) of research endpoints in each study were calculated. Statistical analyses were performed with Stata 12.0. Results A total of 8 studies involving 4,052 gastric cancer patients were eligible and included in the present meta-analysis. The result of the meta-analysis was shown that delaying surgery for less than 8 weeks may not decrease OS (HR = 0.91, 95% CI: 0.80~1.04, p = 0.167) and DFS (HR = 0.96, 95% CI: 0.62~1.50, p = 0.872) in gastric cancer. Our meta-analysis also illustrated that delay in surgery for more than 4 weeks (HR = 0.85, 95% CI: 0.56~1.27, p = 0.421), 6 weeks (HR = 0.88, 95% CI: 0.61~1.27, p = 0.490), and 8 weeks (HR = 0.93, 95% CI: 0.80~1.07, p = 0.314) was also not associated with a decreased OS. Conclusion A delay in surgery of less than 8 weeks is not associated with worse overall survival for patients with gastric cancer.
Collapse
Affiliation(s)
- Jichun Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chenglou Zhu
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Weidong Li
- Clinical Medicine College, Ningxia Medical University, Yinchuan, China
| | - Zhisheng Qiu
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.,Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jian Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.,Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mingxu Da
- Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| |
Collapse
|
6
|
Nitipir C, Parosanu AI, Olaru M, Popa AM, Pirlog C, Iaciu C, Vrabie R, Stanciu MI, Oprescu-Macovei A, Bumbacea D, Negrei C, Orlov-Slavu C. Infection and reinfection with SARS-CoV-2 in cancer patients: A cohort study. Exp Ther Med 2022; 23:399. [PMID: 35619634 PMCID: PMC9115626 DOI: 10.3892/etm.2022.11326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
COVID-19 reinfection, although a controversial issue, is an important clinical problem in cancer patients and beyond. The present study aimed to identify the risk factors associated with worse outcomes in cancer patients with Covid-19 in both first infection and reinfection and to describe the involvement of vaccines in reinfection outcome. The present study enrolled 85 patients with solid tumors who had Covid-19 infection and had not been previously vaccinated. Classical risk factors associated with worse outcomes in cancer patients with second SARS-Cov infection were considered. The patients were followed up retrospectively, measuring mortality at the first and second infection and the vaccination rate after the first infection. The factors associated with the highest risk of mortality at the first infection were, in order of importance: intensive care unit (ICU) admission, unfavorable performance status, radiologically quantifiable presence of oncological disease, and administration of cytotoxic chemotherapy in the period immediately before infection. The risk factors associated with higher mortality from reinfection were ECOG 3-4 performance status and administration of cytotoxic chemotherapy in the period immediately before infection. In the studied patients, mortality from reinfection was not affected by prior vaccination. Thus, bearing in mind all of these risk factors for poor outcomes in cancer patients with solid tumors presenting with Covid-19 can help the treating oncologists make personalized decisions about patient care during the pandemic.
Collapse
Affiliation(s)
- Cornelia Nitipir
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Ioana Parosanu
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Olaru
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ana Maria Popa
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristina Pirlog
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristian Iaciu
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Vrabie
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Miruna Ioana Stanciu
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
| | - Anca Oprescu-Macovei
- Department of Gastroenterology, Agrippa Ionescu Emergency Hospital, 011356 Bucharest, Romania
- Department of Gastroenterology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dragos Bumbacea
- Department of Pneumology, Elias University Emergency Hospital, 11468 Bucharest, Romania
| | - Carolina Negrei
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristina Orlov-Slavu
- Department of Medical Oncology, Elias University Emergency Hospital, 11468 Bucharest, Romania
- Department of Oncology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
7
|
Minkove SJ, Sun J, Li Y, Cui X, Cooper D, Eichacker PQ, Torabi-Parizi P. Comprehensive adjusted outcome data are needed to assess the impact of immune checkpoint inhibitors in cancer patients with COVID-19: Results of a systematic review and meta-analysis. Rev Med Virol 2022; 32:e2352. [PMID: 35416370 PMCID: PMC9111045 DOI: 10.1002/rmv.2352] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
Background Determining how prior immune checkpoint inhibitor (ICI) therapy influences outcomes in cancer patients presenting with COVID‐19 is essential for patient management but must account for confounding variables. Methods We performed a systematic review and meta‐analysis of studies reporting adjusted effects of ICIs on survival, severe events, or hospitalisation in cancer patients with COVID‐19 based on variables including age, gender, diabetes mellitus, hypertension (HTN), chronic obstructive pulmonary disease, and other comorbidities. When adjusted effects were unavailable, unadjusted data were analysed. Results Of 42 observational studies (38 retrospective), 7 reported adjusted outcomes for ICIs and 2 provided sufficient individual patient data to calculate adjusted outcomes. In eight studies, adjusted outcomes were based on ≤7 variables. Over all studies, only one included >100 ICI patients while 26 included <10. ICIs did not alter the odds ratio (95%CI) (OR) of death significantly (random effects model), across adjusted (n = 8) [1.31 (0.58–2.95) p = 0.46; I2 = 42%, p = 0.10], unadjusted (n = 30) [1.06 (0.85–1.32) p = 0.58; I2 = 0%, p = 0.76] or combined [1.09 (0.88;1.36) p = 0.41; I2 = 0%, p = 0.5)] studies. Similarly, ICIs did not alter severe events significantly across adjusted (n = 5) [1.20 (0.30–4.74) p = 0.73; I2 = 52%, p = 0.08], unadjusted (n = 19) [(1.23 (0.87–1.75) p = 0.23; I2 = 16%, p = 0.26] or combined [1.26 (0.90–1.77) p = 0.16; I2 = 25%, p = 0.14] studies. Two studies provided adjusted hospitalisation data and when combined with 13 unadjusted studies, ICIs did not alter hospitalisation significantly [1.19 (0.85–1.68) p = 029; I2 = 5%, p = 0.40]. Results of sensitivity analyses examining ICI effects based on 5 variables were inconclusive. Certainty of evidence was very low. Conclusions Across studies with adjusted and unadjusted results, ICIs did not alter outcomes significantly. But studies with comprehensive adjusted outcome data controlling for confounding variables are necessary to determine whether ICIs impact COVID‐19 outcomes in cancer patients.
Collapse
Affiliation(s)
- Samuel J Minkove
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Yan Li
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Xizhong Cui
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Diane Cooper
- NIH Library, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Q Eichacker
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Parizad Torabi-Parizi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
8
|
Wong YNS, Sng CCT, Ottaviani D, Patel G, Chowdhury A, Earnshaw I, Sinclair A, Merry E, Wu A, Galazi M, Benafif S, Soosaipillai G, Chopra N, Roylance R, Shaw H, Lee AJX. Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital. Cancers (Basel) 2021; 13:6085. [PMID: 34885194 PMCID: PMC8657102 DOI: 10.3390/cancers13236085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March-May 2020; December 2020-February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30-0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.
Collapse
Affiliation(s)
- Yien Ning Sophia Wong
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
| | - Christopher C. T. Sng
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Grisma Patel
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Amani Chowdhury
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Irina Earnshaw
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Alasdair Sinclair
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Eve Merry
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Anjui Wu
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Myria Galazi
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Sarah Benafif
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Gehan Soosaipillai
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Neha Chopra
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Rebecca Roylance
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
- NIHR University College London Hospitals Biomedical Research Centre, London W1T 7DN, UK
| | - Heather Shaw
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK; (Y.N.S.W.); (C.C.T.S.); (D.O.); (G.P.); (A.C.); (I.E.); (A.S.); (E.M.); (A.W.); (M.G.); (S.B.); (G.S.); (N.C.); (R.R.); (H.S.)
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
| |
Collapse
|
9
|
Lu H, Shi Y, Chen K, Chen Z, Zhu H, Niu Y, Xia D, Wu Y. Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis. J Zhejiang Univ Sci B 2021; 22:876-884. [PMID: 34636190 PMCID: PMC8505457 DOI: 10.1631/jzus.b2100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Haohua Lu
- Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yu Shi
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Kelie Chen
- Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhi Chen
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Haihong Zhu
- National Clinical Research Center for Infectious Diseases, Hangzhou 310003, China
| | - Yuequn Niu
- Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Dajing Xia
- Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Yihua Wu
- Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| |
Collapse
|
10
|
Kalinka E, Chmielewska I, Wojas-Krawczyk K. Viral Infection and Lung Cancer Immunotherapy. Front Oncol 2021; 11:577514. [PMID: 34434887 PMCID: PMC8381362 DOI: 10.3389/fonc.2021.577514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
Immunotherapy with immune checkpoint inhibitors (mainly anti-PD1 and anti-PDL1 monoclonal antibodies) became a standard of care in non-small cell lung cancer (NSCLC) patients. Most of the clinical trials excluded patients with hepatitis B (HBV), hepatis C (HCV), and human immunodeficiency virus (HIV) active infection (1-10). Despite the progress in treatment of these infections, they remain an unresolved clinical problem when lung cancer immunotherapy should be initiated in an NSCLC patient. This manuscript summarizes the data from the literature concerning this subgroup of patients including the rationale for immunotherapy initiation depending on the HBV, HCV, or HIV infection status; the risk of adverse events; and the efficacy compared to non-infected patients. One of the crucial questions is how the candidates to immunotherapy should be screened for HBV, HCV, and HIV infections. The year 2020 brought the world a new but dynamic viral problem-severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). The incorporation of known data in oncology guidelines became a burning need, and then, which group of the infected patients can be treated with immunotherapy despite the infection. Oncologists should also know if these patients should receive antiviral therapy and what are the safe combinations in these settings. We also indicate which of the adverse events should be monitored carefully during checkpoint inhibitor treatment.
Collapse
Affiliation(s)
- Ewa Kalinka
- Department of Oncology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Izabela Chmielewska
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Kamila Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
11
|
Bisceglia I, Gabrielli D, Canale ML, Gallucci G, Parrini I, Turazza FM, Russo G, Maurea N, Quagliariello V, Lestuzzi C, Oliva S, Di Fusco SA, Lucà F, Tarantini L, Trambaiolo P, Gulizia MM, Colivicchi F. ANMCO POSITION PAPER: cardio-oncology in the COVID era (CO and CO). Eur Heart J Suppl 2021; 23:C128-C153. [PMID: 34456641 PMCID: PMC8388610 DOI: 10.1093/eurheartj/suab067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic and its impact on patients with cancer and cardiovascular disease have confirmed the particular vulnerability of these populations. Indeed, not only a higher risk of contracting the infection has been reported but also an increased occurrence of a more severe course and unfavourable outcome. Beyond the direct consequences of COVID-19 infection, the pandemic has an enormous impact on global health systems. Screening programmes and non-urgent tests have been postponed; clinical trials have suffered a setback. Similarly, in the area of cardiology care, a significant decline in STEMI accesses and an increase in cases of late presenting heart attacks with increased mortality and complication rates have been reported. Health care systems must therefore get ready to tackle the 'rebound effect' that will likely show a relative increase in the short- and medium-term incidence of diseases such as heart failure, myocardial infarction, arrhythmias, and cardio- and cerebrovascular complications. Scientific societies are taking action to provide general guidance and recommendations aimed at mitigating the unfavourable outcomes of this pandemic emergency. Cardio-oncology, as an emerging discipline, is more flexible in modulating care pathways and represents a beacon of innovation in the development of multi-specialty patient management. In the era of the COVID-19 pandemic, cardio-oncology has rapidly modified its clinical care pathways and implemented flexible monitoring protocols that include targeted use of cardiac imaging, increased use of biomarkers, and telemedicine systems. The goal of these strategic adjustments is to minimize the risk of infection for providers and patients while maintaining standards of care for the treatment of oncologic and cardiovascular diseases. The aim of this document is to evaluate the impact of the pandemic on the management of cardio-oncologic patients with the-state-of-the-art knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) in order to optimize medical strategies during and after the pandemic.
Collapse
Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido Di Camaiore, LU, Italy
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I, Torino, Italy
| | | | - Giulia Russo
- Cardiovascular and Sports Medicine Department, ASUGI Trieste, Trieste, Italy
| | - Nicola Maurea
- Cardiology Department, Fondazione Pascale, Napoli, Italy
| | | | - Chiara Lestuzzi
- Cardiology Department, Centro di Riferimento Oncologico (CRO), Aviano, PN, Italy
| | - Stefano Oliva
- Cardio-Oncology Department, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Osp. Metropol-Bianchi Melacrino-Morelli, Reggio Calabria, Italy
| | - Luigi Tarantini
- Cardiology Department, Presidio Ospedaliero. Santa Maria Nuova—AUSL RE IRCCS, Reggio Emilia, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| |
Collapse
|
12
|
Söhn C, Bott A. [COVID-19 severity and outcomes in patients with cancer: a matched cohort study]. Strahlenther Onkol 2021; 197:755-756. [PMID: 34109440 PMCID: PMC8189273 DOI: 10.1007/s00066-021-01797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Claudius Söhn
- Klinik für Innere Medizin 5, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - Alexander Bott
- Klinik für Innere Medizin 5, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| |
Collapse
|
13
|
Delivery of systemic anti-cancer therapy during the COVID-19 pandemic. Ir J Med Sci 2021; 191:559-562. [PMID: 33977394 PMCID: PMC8112878 DOI: 10.1007/s11845-021-02631-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The first confirmed case of COVID-19 in Ireland was on February 29th 2020. From March until late April, the number of cases increased exponentially. The delivery of anti-cancer therapy during the COVID-19 pandemic was extremely challenging. In order to balance the benefits of continuing anti-cancer therapy with the associated increased hospital visits, combined with the risk of COVID-19 infection, we undertook a series of system changes in the delivery of cancer care. METHODS Patients who attended our dayward over a 4-month period were included. Data were obtained from patient and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 at two separate timepoints: prior to their visit via telephone, and using a symptom questionnaire on arrival at the hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab arranged. RESULTS A total of 456 patients attended from January 1st to April 30th. The numbers of visits from January to April were 601, 586, 575, and 607, respectively. During this period, there were 2369 patient visits to the dayward and 1953 (82%) intravenous regimens administered. Of the 416 visits that did not lead to treatment, 114 (27%) were scheduled non-treatment review visits, 194 (47%) treatments were held due to disease-related illness, and 108 (26%) treatments were held due to treatment-related complications. Screening measurements were implemented on March 18th due to rising COVID-19 prevalence in the general population. Overall, 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. CONCLUSIONS With careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID-19 pandemic is possible.
Collapse
|
14
|
Bandinelli L, Ornell F, von Diemen L, Kessler FHP. The Sum of Fears in Cancer Patients Inside the Context of the COVID-19. Front Psychiatry 2021; 12:557834. [PMID: 33897477 PMCID: PMC8058213 DOI: 10.3389/fpsyt.2021.557834] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies.
Collapse
Affiliation(s)
- Lucas Bandinelli
- Postgraduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Queen's University Department of Psychiatry, Providence Care Hospital, Kingston, ON, Canada
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
15
|
Garassino MC, Ribas A. At the Crossroads: COVID-19 and Immune-Checkpoint Blockade for Cancer. Cancer Immunol Res 2021; 9:261-264. [PMID: 33452008 PMCID: PMC8052929 DOI: 10.1158/2326-6066.cir-21-0008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
The immunomodulatory effects of immune-checkpoint blockade (ICB) therapy for cancer may act at the crossroads between the need to increase antiviral immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to decrease the inflammatory responses in severe cases of coronavirus disease 2019 (COVID-19). There is evidence from preclinical models that blocking programmed death receptor 1 (PD1) protects against RNA virus infections, which suggests that patients with cancer receiving ICB may have lower rates of viral infection. However, given the heterogeneity of patient characteristics, this would be difficult to demonstrate using population-based registries or in clinical trials. Most studies of the impact of ICB therapy on the course of COVID-19 have centered on studying its potential detrimental impact on the course of the COVID-19 infection, in particular on the development of the most severe inflammatory complications. This is a logical concern as it is becoming clear that complications of COVID-19 such as severe respiratory distress syndrome are related to interferon signaling, which is the pathway that leads to expression of the PD1 ligand PD-L1. Therefore, PD1/PD-L1 ICB could potentially increase inflammatory processes, worsening the disease course for patients. However, review of the current evidence does not support the notion that ICB therapy worsens complications from COVID-19, and we conclude that it supports the continued use of ICB therapy during the COVID-19 pandemic provided that we now collect data on the effects of such therapy on COVID-19 vaccination.
Collapse
Affiliation(s)
- Marina Chiara Garassino
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale di Tumori, Milan, Italy
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, California.
| |
Collapse
|
16
|
New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era. J Clin Med 2021; 10:jcm10040587. [PMID: 33557273 PMCID: PMC7915471 DOI: 10.3390/jcm10040587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario.
Collapse
|